Abstract:Objective：To analyze and compare the effect of early surgical treatment and nonsurgical treatment for patients with severe acute pancreatitis. Methods：Acccording to the including criteria, five randomized controlled trials of this topic were enrolled into the analysis. The detail about the trial design, characters of the subjects, results of the studies were reviewed and analysed by using Revman 4.2 software. Results：Compared with nonsurgical treatment, early surgical treatment was associated with a significantly higher incidence of mortality (RR 3.42, 95% CI 1.81～6.47, P=0.0002) and complications (RR 3.16, 95% CI 2.15～4.64, P<0.00001), and with a lower cure rate (RR 0.83, 95% CI 0.75～0.92, P=0.0005). Conclusions：The findings suggest that for early severe acute pancreatitis, non-operative management should be selected routinely as the first choice of treatment and do not support operative treatment.